Cultural sensitivity and day care workers. Examination of a worksite based cardiovascular disease prevention project.

Reaching workers in small worksites presents economic and access barriers for occupational health nurses. Some barriers can be overcome through strategies based on cultural sensitivity. Day care centers employ young, low income, mostly minority women in settings with few workers onsite at any one center. These settings were used to develop a culturally sensitive approach tested through onsite cardiovascular screening, informal interviews, and discussion of behavior change for better health. The study examined both the impact of the Healthier People Health Risk Appraisal (HPHRA) as a culturally appropriate recruitment strategy to involve a group of child day care workers in a cardiovascular disease (CVD) screening and risk reduction program and the effect of that program on observable CVD measures. Faculty and students from an institution of higher education forged a trust relationship with day care providers at nine day care centers in a large metropolitan area. Cardiovascular health was the impetus for the project because minority populations in the southeastern United States have high heart attack and stroke mortality and morbidity rates. Participation rates in the project increased from 26% of the day care workers in the first year of the project to 73% when long term relationships were built on culturally appropriate strategies. The project's culturally sensitive educational intervention focused on individual risks and lifestyle. Statistical analysis of outcomes of the intervention and personal interviews demonstrated the improvement of cardiovascular status in the day care workers. This psychosocial approach can provide the foundation for culturally sensitive care in larger occupational and community settings.